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Your gift to Maimonides Medical Center will support a broad range of life-saving services – funding vital research projects, graduate medical education and a host of medical services from pediatric to cardiac to cancer care and more.
Make a difference through a tax-deductible gift today. The information you provide here is secure and will not be shared. For more details, please read our Privacy Policy.
Please print the form below and mail it to:
The Development Office
Maimonides Medical Center
4802 Tenth Avenue
Brooklyn, NY 11219
Enclosed please find my tax-deductible donation made payable to the Maimonides Medical Center in the amount of:
| __ US $25 |
__ US $50 |
__ US $100 |
__ US $250 |
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| __ US $500 |
Other:_____ |
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Designation:
| __ Where it's needed most |
__ Cancer Center |
__ Heart & Vascular Center |
| __ Stroke Center |
__ Infants & Children's Hospital |
__ Geriatric Care |
| __ Obstetrics |
__ Radiology/Imaging |
__ Surgery |
| __ Urology |
__ Women's Health |
__ Community Outreach |
| Other ___________________ |
Referral Source:
| __ Google or other search engine |
__ Doctor recommendation |
__ A friend |
| __ Email |
__ Direct mail |
__ Website |
| __ I was a patient |
__ Family/friend of patient |
__ News story |
| __ Advertisement |
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If donating by credit card, please provide the following information:
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Visa: _________
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Mastercard: _________ |
AMEX: _________
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Discover: _________ |
Credit Card Number_____________________________________
Expiration Date_________________________________________
Card Verification #_______________________________________
Name_________________________________________________
Address_______________________________________________
City/State/Zip/Country____________________________________
Phone_________________________________________________
Email__________________________________________________
Acknowledgement of donation will be sent via email
Signature_______________________________________________
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